Punjab

Sangrur

CC/363/2015

Manjeet Kaur - Complainant(s)

Versus

The Gurbukshpura Multipurpose - Opp.Party(s)

Shri Rajinder Goyal

09 Feb 2016

ORDER

 

DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SANGRUR

                            

                                                                    Complaint no. 363

                                                                     Instituted on:  01.06.2015

                                                                   Decided on:    09.02.2016

 

Manjeet Kaur w/o Late Harbans Singh son of Budh Singh  resident of Village Tibba, Tehsil Dhuri, District, Sangrur.

                                                                  …. Complainant.    

                                         Versus

 

1.     The Gurbukshpura Multipurpose Co-operative Agriculture Service Society, Gurbukshpura, Tehsil Dhuri, District Sangrur through its Secretary.        

 

2.     The Sangrur Central Co-operative Bank Limited, Branch Barri, Tehsil Dhuri, District Sangrur through its Branch Manager.  

 

3.     The Sangrur Central Coop Bank Ltd. Patiala Gate Sangrur through its D.M.

 

4.     Liberty Videocon General Insurance Company Limited, 10^th Floor, Tower A, Peninsula Business Park, Ganpatrao Kadam Garg, Lower Parel, Mumbai 400 013 through its authorized signatory.                                                                                                            ….Opposite parties.

 

FOR THE COMPLAINANT:      Shri Rajinder Goyal,  Advocate                          

 

FOR OPP. PARTIES No.1to3 :  Shri Amit Goyal,  Advocate                    

 

FOR THE OPP. PARTY No.4:  Shri Bhushan Garg, Advocate                    

 

 

Quorum

         

                   Sukhpal Singh Gill, President

K.C.Sharma, Member

Sarita Garg, Member

                 

ORDER:  

 

Sukhpal Singh Gill, President

 

1.             Manjeet Kaur, complainant has preferred the present complaint against the opposite parties (referred to as OPs in short) on the ground that being the member and account holder of OPs No.1to3, husband of the complainant was insured with OP No.4 for Rs.50,000/-  under group personal accident policy under Kissan Credit card with OP No.1.  The husband of the complainant met with an accident on 07.10.2013 and unfortunately he died  at the spot and post mortem was performed. DDR No.32 dated 7.10.2013 was lodged at P.S.Sherpur.  The complainant submitted the required documents with OP No.3 through OP No.1. Thereafter OP No.3 further sent the said documents to OP No.4. The complainant was surprised to receive letter dated 16.07.2014  from OP No.4 along with letter dated 25.08.2014 vide which OP No.4 repudiated the claim of the complainant on the grounds of delay in intimation and non-submission of documents which is wrong. Thus, alleging deficiency in service on the part of OPs, the complainant has sought following reliefs:- 

i)      OPs be directed to pay a sum of Rs.50,000/- being insured amount along with interest @18% per annum from the date of death till payment,  

ii)     OPs be directed to pay to the complainant a sum of Rs.40000/- as compensation   on account of mental agony, harassment and Rs.5500/- as litigation expenses.

2.             In reply filed by the OP No.1 preliminary objections on the grounds of maintainability, cause of action, locus standi and suppression of material facts have been taken up. It is submitted that husband of the complainant namely Harbans Singh was a Kissan Credit Card holder having account number 353 with OP no.1. But the insurance claim if any was to be paid to the complainant by insurance company i.e. OP No.4. Thus, there is no deficiency in service on the part of the OP No.1.

3.             In reply filed by OPs No.2&3, legal objections on the grounds of maintainability, concealment of material facts and cause of action have been taken up. On merits, it is submitted that husband of the complainant namely Harbans Singh was a Kissan Credit Card holder having account number 353 with OP no.1. It is admitted that the husband of the complainant was insured with OP No.4 for Rs.50,000/- under group personal accident. It is submitted that the claim of the complainant was forwarded vide letter number LD/12007 dated 25.01.2014 to the insurance company through registered post.  It is correct that the claim of the complainant was repudiated vide letter dated 16.07.2014  and the complainant was duly intimated about the same vide letter dated 25.08.2014 on the ground of delay and non-submission of documents.

4.             In reply filed by OP No.4, legal objections have been taken up on the ground that  it appears that  deceased died on  7.10.2013 whereas the intimation thereof was given to this opponent as much as after a delay of 210 days.  It is submitted that even no  information was given to the answering OP before the cremation of Harbans Singh  and the complainant  even had failed to supply the documents demanded vide letters dated 13.06.2014 and 12.07.2014.  Thus, the OP No.4 had rightly denied the claim of the  complainant vide letter dated 16.07.2014. Thus, there is no deficiency in service on the part of OP No.4.

5.             The complainant has tendered documents Ex.C-1 to Ex.C-7 and closed evidence. On the other hand, OPs have tendered documents Ex.OP1/1 to Ex.OP1/4, Ex. OPs2&3/1 to Ex.OPs2&3/5, Ex.OP4/1 to Ex.OP4/9  and closed evidence.

6.             After hearing the arguments of learned counsel for the parties and on perusal of the documents placed on record, we find that the husband of the complainant was insured for Rs.50,000/- under group personal accident policy with No.4 as he was having a Kissan Credit Card of OP No.1. The deceased  policy holder died on 07.10.2013 due to an accident and  in support of her version, the complainant has placed on record copy of DDR and post mortem report which are Ex.C-3and Ex.C-5.  The complainant submitted the claim papers with OP No.3 through OP No.1 and the same was submitted to the OP No.4 after processing the formalities and verifying the contents thereof but the OP No.4 had repudiated the claim vide letter dated 16/07/2014 Ex.C-6 on the ground that the claim papers were received by them on 11.06.2014. Learned counsel for the OP No.4 has vehemently argued that as per the terms and conditions of the policy the claimant should have submitted the claim within 15 days of the actual date of the accident.

7.             On carefully examining the terms and conditions of the policy contained in document Ex.OP4/3 under the head “ Notification of claim”  we find  that though the intimation was to be given in 15 days but then it has also been mentioned in this document that “ however, the company may condone the delay on merits of the claim subject to getting satisfied  that the delay in notification was due to reasons beyond the control of the insured/ insured person/ nominee”. In the present complaint, the insured died suddenly and the nominee had  submitted the claim and in such circumstances  it cannot be said that  the complainant/ nominee has submitted the claim with deliberate delay. Moreover, this condition does not even say that if the notice is not given within 15 days then the claim shall stand repudiated.  In support of his version learned counsel for the complainant has submitted the judgment of Hon’ble Tamilnadu  State Commission, Chennai delivered in case A.P. No.850/99 titled as  The Branch Manager, New India Assurance Company Limited Vs. Soosai, 2004(1) CLT 672, wherein it has been held that “ this condition does not say that if notice is not given within a month, the claim shall stand repudiated. On the other hand, it  would only require that  a notice to be given within a month after the event. It does not bar or state that failure to issue any notice within the prescribed period of one month would estop or eschew or prohibit anyone from making a claim. Even if there is such a condition, it cannot be upheld since it is unconscionable. The contract of insurance being one based upon honesty and good faith, such trivial technicalities cannot be allowed to sway the ultimate aim and goal of insurance. Therefore, we are unable to accept the contentions of the learned counsel for the  appellant and that the repudiation is justified on account of the proviso and the conditions”.

8.             In the present complaint, OPs No.2 and 3 have produced dispatch register alongwith postal receipt which clearly shows that  the claim papers of the complainant was sent to the OP No.4  through registered post  on 28.01.2014  thus, the OP No.4 has wrongly alleged that the claim was received by them  on 11.06.2014. So, in the light of above, we do not find that there is inordinate  delay  in the present complaint with regard to the submission of the claim papers by the complainant and in the light of above discussion we do not find any relevance of the ruling  titled as  Sasanka Mohapatra  Vs.  New India Assurance Company Limited,  2008 (3) CLT 149  cited by the OP No.3. Since, the copies of DDR and post mortem report Ex.C-3 and Ex.C-4      have been produced on the file by the complainant which show that the DDR was lodged on 07.10.2013 and post mortem was performed on 08.10.2013, there is no possibility to provide the same with the claim papers by the complainant. Moreover, if these documents had already been provided by the complainant then there is no requirement to provide the other documents.     

9.             So, in view of the above discussion made above, we find that the OP No.4 is not only deficient in service but also indulged in unfair trade practice and has enforced the complainants to seek legal remedy in order to receive their rightful claim which has been supported by cogent evidence. The Hon’ble Punjab & Haryana High Court  in case tilted as New India Assurance Company Limited Vs. Smt. Usha Yadav and others 2008 (3) R.C.R. 9 ( civil) 111 has held that the insurance companies  are in the habit to take these type of projections to save themselves from paying the insurance claim. The Insurance companies are only interested in earning the premiums and find ways and means to decline claims.

10.           Further, the Hon’ble Supreme Court of India in Madras Port Trust Vs. Hymanshu International, (1979) 4 SCC 176 whereby, it deprecated the practice  often adopted by governmental and public authorities, of denying  just claims of citizens  on technical pleas, even though the claim lodged with them was otherwise well founded”. The relevant observations are extracted hereinbelow:-

“ ……2. We do not think that this is a fit case where we should  proceed to determine whether the claim of the respondent was  barred by Section 110 of the Madras Port Trust Act (II of 1905) . The plea  of limitation based on this Section is one which the court always looks upon with disfavour and it is unfortunate that a public authority like the Port Trust should, in all morality and justice, take up such  a plea to defeat  a just claim of the citizen.  It is high time that governments and public authorities adopt the practice of not relying upon technical  pleas for the purpose of defeating legitimate claims of citizens and do what  is fair and just to the citizens”. Here, it is obvious that the claim of the complainant was a just claim supported by the cogent and reliable evidence  of the complainant. Moreover, IRDA’s circular dated 20.09.2011, 14.4 clearly  says that genuine claims cannot be rejected on account of delay in intimation,  and that, the insurer’s decision to reject a claim must be based on “ sound logic” and “ valid grounds”.  

11.           In the light above facts, we allow the complaint against OP No.4 and direct the OP No.4 to pay a sum of Rs.50000/- being insured amount along with interest 9% per annum from the date of filing of complaint till realization. We further order the OP No.4 to pay to the complainant a sum of Rs.10000/- on account of mental agony and harassment and also to pay a sum of Rs.5000/- as litigation expenses.

12.           This order of ours shall be complied with within 60 days from the receipt of copy of the order.  Copy of the order be supplied to the parties free of charge. File be consigned to records in due course.       

Announced

                February, 2016

 

 

 

( Sarita Garg)       ( K.C.Sharma)       (Sukhpal Singh Gill)                                                                                                                                      

             Member                Member               President

 

BBS/-